Eating Disorders Practice Questions

Q: A patient of normal body weight presents with parotid abscess and dental caries. The patient becomes irritable when questioned about eating habits. What is the most probable diagnosis?

Bulimia nervosa. **Explanation:** The clinical presentation of **Bulimia Nervosa (BN)** is characterized by a cycle of binge eating followed by compensatory behaviors (purging). This patient exhibits classic physical signs of self-induced vomiting: 1. **Parotid Gland Enlargement/Abscess:** Chronic vomiting leads to sialadenosis (swelling of the salivary glands) due to autonomic stimulation and retrograde inflammation. 2. **Dental Caries/Erosion:** Frequent exposure to gastric acid causes the destruction of tooth enamel (perimolysis), primarily on the lingual surfaces. 3. **Normal Body Weight:** Unlike Anorexia Nervosa, patients with Bulimia are typically of **normal weight or slightly overweight**, which is a key diagnostic differentiator. **Analysis of Incorrect Options:** * **Anorexia Nervosa:** While purging can occur (Binge-eating/purging type), the hallmark is a **significantly low body weight** (BMI <18.5 kg/m²) and an intense fear of gaining weight. * **Adjustment Disorder:** This is a psychological response to an identifiable stressor resulting in emotional or behavioral symptoms; it does not manifest with specific physical signs like parotid abscesses or dental erosion. * **Conversion Disorder:** Involves unexplained neurological symptoms (e.g., paralysis, blindness) without a physical cause, unrelated to eating patterns or dental health. **High-Yield Clinical Pearls for NEET-PG:** * **Russell’s Sign:** Calluses or scars on the knuckles/dorsum of the hand from inducing vomiting; a classic sign of BN. * **Metabolic Profile:** Bulimia often leads to **Hypokalemic Hypochloremic Metabolic Alkalosis**. * **Drug of Choice:** **Fluoxetine** (SSRI) is the only FDA-approved medication for Bulimia Nervosa. * **Mallory-Weiss Tears:** Forceful vomiting in BN can lead to esophageal mucosal tears and hematemesis.

Q: What is the treatment for bulimia nervosa?

Escitalopram. **Explanation:** The primary pharmacological treatment for **Bulimia Nervosa (BN)** involves the use of **Selective Serotonin Reuptake Inhibitors (SSRIs)**. Serotonin dysregulation is implicated in the binge-purge cycle; SSRIs help reduce the frequency of binge eating episodes and compensatory behaviors (purging), even in patients without comorbid depression. * **Why Escitalopram is correct:** As an SSRI, Escitalopram is effective in managing BN. While **Fluoxetine** is the only FDA-approved drug specifically for Bulimia (often used at higher doses like 60mg/day), other SSRIs like Escitalopram are considered first-line pharmacological options in clinical practice. * **Why the others are incorrect:** * **Pimozide:** A typical antipsychotic primarily used for Tourette’s syndrome and delusional parasitosis. * **Clozapine:** An atypical antipsychotic reserved for treatment-resistant schizophrenia; it is associated with significant weight gain, which is contraindicated in patients with eating disorders. * **Reserpine:** An older antihypertensive and antipsychotic that depletes monoamines; it can actually trigger severe depression. **High-Yield Clinical Pearls for NEET-PG:** 1. **First-line Treatment:** Nutritional rehabilitation and **Cognitive Behavioral Therapy (CBT-BN)** are the gold standards. 2. **Drug of Choice:** Fluoxetine (60 mg) is the most frequently tested SSRI for Bulimia. 3. **Absolute Contraindication:** **Bupropion** must be avoided in Bulimia and Anorexia because it lowers the seizure threshold, especially in patients with electrolyte imbalances due to purging. 4. **Physical Sign:** Look for **Russell’s sign** (calluses on knuckles) and parotid gland enlargement in clinical vignettes.

Q: Which feature differentiates binge eating disorder from bulimia nervosa?

Absence of recurrent episodes of binge eating. **Explanation:** The fundamental distinction between Binge Eating Disorder (BED) and Bulimia Nervosa (BN) lies in the **absence of inappropriate compensatory behaviors** in BED. 1. **Why Option B is the conceptual differentiator:** Both BED and BN involve recurrent episodes of binge eating (consuming large amounts of food with a sense of loss of control). However, in Bulimia Nervosa, the binge is followed by compensatory actions to prevent weight gain (e.g., self-induced vomiting, laxative abuse, excessive exercise, or fasting). In Binge Eating Disorder, these compensatory behaviors are absent. *Note: There appears to be a discrepancy in the provided key. Option B is the standard clinical differentiator. If Option A is marked correct, it is technically incorrect as both disorders **require** recurrent binge eating episodes for diagnosis.* 2. **Analysis of Incorrect Options:** * **Option A:** Incorrect because recurrent binge eating is the core requirement for *both* BED and BN. * **Option C:** Incorrect because marked distress regarding the eating behavior is a diagnostic criterion for both disorders. * **Option D:** While patients with BED are often overweight or obese, weight gain is a clinical consequence, not a diagnostic criterion used to differentiate the two. **High-Yield Clinical Pearls for NEET-PG:** * **Time Criteria:** For both BED and BN (DSM-5), episodes must occur at least **once a week for 3 months**. * **BMI:** Patients with Bulimia Nervosa usually have a **normal or slightly high BMI**, whereas patients with Anorexia Nervosa (Binge-purge type) have a **low BMI** (<18.5 kg/m²). * **Treatment of Choice:** * **BN:** Fluoxetine (high dose, 60mg) + CBT. * **BED:** Psychotherapy (CBT/IPT) is first-line; Lisdexamfetamine is the only FDA-approved medication.

Q: All of the following are true about bulimia nervosa, except?

Weight loss. **Explanation:** The core clinical feature that distinguishes **Bulimia Nervosa (BN)** from Anorexia Nervosa (AN) is the patient’s weight. In Bulimia Nervosa, patients typically maintain a **normal or slightly above-normal body weight** (BMI ≥ 18.5 kg/m²). Significant weight loss is the hallmark of Anorexia Nervosa; if a patient meets the criteria for Bulimia but is significantly underweight, the diagnosis shifts to Anorexia Nervosa (Binge-eating/Purging type). **Analysis of Options:** * **A. Binge eating:** This is a mandatory diagnostic criterion. It involves eating an amount of food definitely larger than what most people would eat in a discrete period, accompanied by a sense of loss of control. * **B. Self-induced vomiting:** This is the most common compensatory behavior used to prevent weight gain after a binge. * **D. Purgative abuse:** This includes the misuse of laxatives, diuretics, or enemas. Along with vomiting and excessive exercise, these are "inappropriate compensatory behaviors" central to the diagnosis. **Clinical Pearls for NEET-PG:** 1. **Russell’s Sign:** Calluses or scars on the knuckles due to repeated self-induced vomiting (high-yield physical finding). 2. **Electrolyte Imbalance:** The most common metabolic abnormality is **Hypokalemic Hypochloremic Metabolic Alkalosis**. 3. **Parotid Gland Swelling:** Chronic vomiting leads to sialadenosis (painless enlargement of salivary glands). 4. **Drug of Choice:** **Fluoxetine** (SSRI) is the only FDA-approved medication for Bulimia Nervosa, typically used at higher doses (60mg). 5. **Contraindication:** **Bupropion** is strictly contraindicated in patients with eating disorders due to an increased risk of seizures.

Q: Which of the following statements is false regarding bulimia nervosa?

Mortality is high. ### Explanation **Bulimia Nervosa (BN)** is characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors (purging, excessive exercise, or fasting) to prevent weight gain. **Why Option D is the Correct Answer (False Statement):** While Bulimia Nervosa is associated with significant morbidity (e.g., electrolyte imbalances, dental erosion), its **mortality rate is relatively low** (approx. 2% per decade). In contrast, **Anorexia Nervosa (AN)** has the highest mortality rate of any psychiatric disorder (approx. 5-10% per decade) due to medical complications of starvation or suicide. Therefore, stating mortality is high for BN is incorrect. **Analysis of Incorrect Options (True Statements):** * **A. Weight is normal:** Unlike Anorexia Nervosa (where BMI is <18.5 kg/m²), patients with Bulimia Nervosa typically maintain a **normal or slightly above-normal weight**. This often makes the disorder harder to detect by family members. * **B. Common in females:** BN is significantly more prevalent in females, with a female-to-male ratio of approximately 10:1. * **C. Onset in early adulthood:** The peak age of onset for BN is typically late adolescence or **early adulthood** (18–24 years), slightly later than the onset of Anorexia Nervosa (mid-adolescence). --- ### High-Yield Clinical Pearls for NEET-PG: * **Russell’s Sign:** Calluses on the knuckles/back of the hand due to repeated self-induced vomiting. * **Metabolic Profile:** Hypokalemic hypochloremic metabolic alkalosis (due to vomiting). * **Parotid Gland Enlargement:** Often seen in chronic purgers ("chipmunk facies"). * **Drug of Choice:** **Fluoxetine** (SSRI) is the only FDA-approved medication for BN; it helps reduce binge-purge cycles. * **Contraindication:** **Bupropion** is strictly contraindicated in bulimic patients due to an increased risk of seizures.

Q: Which of the following statements about Bulimia nervosa is false?

More common in males.. ### Explanation **Bulimia Nervosa (BN)** is an eating disorder characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors to prevent weight gain. **1. Why Option A is the Correct Answer (False Statement):** Bulimia nervosa is significantly **more common in females** than in males, with a female-to-male ratio of approximately **10:1**. The lifetime prevalence is about 1–3% in women and only 0.1% in men. Therefore, the statement that it is more common in males is incorrect. **2. Analysis of Other Options:** * **Option B (Age Group):** BN typically has a slightly later onset than Anorexia Nervosa. While it often begins in late adolescence, it is frequently seen and diagnosed in the **20–40 year age group**. * **Option C (Pathophysiology):** **Serotonin (5-HT)** and norepinephrine are heavily implicated. Low serotonin levels are linked to reduced satiety and increased impulsivity, which triggers binge episodes. This is why SSRIs (specifically Fluoxetine) are effective in treatment. * **Option D (Clinical Feature):** This is the hallmark of BN. Patients experience a "loss of control" during binge eating, followed by purging (vomiting, laxatives) or non-purging (excessive exercise, fasting) behaviors. **3. High-Yield Clinical Pearls for NEET-PG:** * **Body Weight:** Unlike Anorexia, patients with Bulimia usually maintain a **normal or slightly above-normal BMI**. * **Physical Signs:** Look for **Russell’s sign** (calluses on knuckles from self-induced vomiting) and **parotid gland swelling** (sialadenosis). * **Electrolytes:** Recurrent vomiting leads to **Hypokalemic Hypochloremic Metabolic Alkalosis**. * **Drug of Choice:** **Fluoxetine** (at a higher dose of 60mg/day) is the only FDA-approved medication for BN. * **Contraindication:** **Bupropion** is strictly contraindicated in bulimic patients due to an increased risk of seizures.

Q: Pagophagia involves eating which of the following?

Ice. **Explanation:** **Pagophagia** is a specific form of **Pica**, an eating disorder characterized by the persistent craving and compulsive consumption of non-nutritive, non-food substances. 1. **Why Option A is Correct:** The term is derived from the Greek words *pagos* (frost/ice) and *phagia* (to eat). Pagophagia specifically refers to the compulsive consumption of **ice**, freezer frost, or iced water. Clinically, it is a highly specific sign often associated with **Iron Deficiency Anemia (IDA)**. Interestingly, studies suggest that chewing ice may increase alertness and cognitive function in patients with IDA by increasing cerebral blood flow. 2. **Why Other Options are Incorrect:** * **Option B (Sand):** The consumption of sand or soil is termed **Geophagia**. * **Option C (Clay):** This is also a form of **Geophagia**. It is common in certain cultures and during pregnancy, often linked to iron or zinc deficiency. * **Option D (Salt):** While salt cravings can occur in conditions like Addison’s disease, it is not classified under Pica as salt is a food additive/mineral. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis:** According to DSM-5, the behavior must persist for at least **one month** and be developmentally inappropriate (child >2 years old). * **Associations:** Pica is frequently associated with **Iron Deficiency Anemia**, **Zinc deficiency**, and **Pregnancy**. It is also seen in individuals with Intellectual Disabilities and Autism. * **Complications:** Lead poisoning (from paint chips/Plumbism), intestinal obstruction, and dental injuries. * **Treatment:** The primary approach is treating the underlying nutritional deficiency and using behavioral therapy.

Q: Which of the following psychiatric disorders is characterized by the clinical sign presented?

Bulimia Nervosa. ***Bulimia Nervosa*** - **Russell's sign** (calluses/scarring on dorsal knuckles) is pathognomonic for bulimia nervosa, resulting from repeated **self-induced vomiting**. - Characterized by **binge eating episodes** followed by compensatory behaviors like vomiting, laxative use, or excessive exercise. *Mania* - Presents with **elevated mood**, **grandiosity**, **decreased need for sleep**, and **increased goal-directed activity**. - Does not involve **self-induced vomiting** or eating-related behaviors that would cause Russell's sign. *Depression* - Characterized by **persistent low mood**, **anhedonia**, **fatigue**, and **changes in appetite or sleep**. - May involve **weight loss** due to decreased appetite, but not associated with **self-induced vomiting** or Russell's sign. *Necrophagia* - An extremely rare paraphilia involving **consumption of dead bodies** or **corpses**. - Not associated with **self-induced vomiting** or the development of **calluses on knuckles** from purging behaviors.

Question 1

A patient of normal body weight presents with parotid abscess and dental caries. The patient becomes irritable when questioned about eating habits. What is the most probable diagnosis?

Accepted Answer

Bulimia nervosa

Answer

Adjustment disorder

Answer

Anorexia nervosa

Answer

Conversion disorder

Question 2

Which of the following is/are not a feature of anorexia nervosa?

Accepted Answer

Hallucination

Answer

Strict dieting

Answer

Amenorrhoea

Answer

Distortion of body image

Question 3

What is the treatment for bulimia nervosa?

Accepted Answer

Escitalopram

Answer

Pimozide

Answer

Clozapine

Answer

Reserpine

Question 4

Which feature differentiates binge eating disorder from bulimia nervosa?

Accepted Answer

Absence of recurrent episodes of binge eating

Answer

Absence of inappropriate compensatory behaviors

Answer

Presence of marked distress associated with binge eating

Answer

Significant increase in weight following binge eating episodes

Question 5

All of the following are true about bulimia nervosa, except?

Accepted Answer

Weight loss

Answer

Binge eating

Answer

Self-induced vomiting

Answer

Purgative abuse

Question 6

Which of the following statements is false regarding bulimia nervosa?

Accepted Answer

Mortality is high

Answer

Weight is normal

Answer

Common in females

Answer

Onset in early adulthood

Question 7

Which of the following statements about Bulimia nervosa is false?

Accepted Answer

More common in males.

Answer

Seen in the 20-40 year age group.

Answer

Serotonin is implicated in its pathophysiology.

Answer

Characterized by binge eating followed by compensatory behaviors.

Question 8

Pagophagia involves eating which of the following?

Accepted Answer

Ice

Answer

Sand

Answer

Clay

Answer

Salt

Question 9

Which of the following psychiatric disorders is characterized by the clinical sign presented?

Accepted Answer

Bulimia Nervosa

Answer

Mania

Answer

Depression

Answer

Necrophagia

Question 10

Anorexia nervosa is most common in which demographic group?

Accepted Answer

Adolescents

Answer

Middle-aged adults

Answer

Males

Answer

Elderly individuals

Eating Disorders — MCQs

Eating Disorders — MCQs

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